Department of Orthopaedic Surgery, NYU Langone Health, New York, New York; Division of Orthopaedic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
Department of Orthopaedic Surgery, NYU Langone Health, New York, New York.
J Arthroplasty. 2023 Jun;38(6):1016-1023. doi: 10.1016/j.arth.2023.02.065. Epub 2023 Feb 28.
The impact of preoperative nasal colonization with methicillin resistant staphylococcus aureus (MRSA) on total joint arthroplasty (TJA) outcomes is not well understood. This study aimed to evaluate complications following TJA based on patients' preoperative staphylococcal colonization status.
We retrospectively analyzed all patients undergoing primary TJA between 2011 and 2022 who completed a preoperative nasal culture swab for staphylococcal colonization. Patients were 1:1:1 propensity matched using baseline characteristics, and stratified into 3 groups based on their colonization status: MRSA positive (MRSA+), methicillin sensitive staphylococcus aureus positive (MSSA+), and MSSA/MRSA negative (MSSA/MRSA-). All MRSA+ and MSSA + underwent decolonization with 5% povidone iodine, with the addition of intravenous vancomycin for MRSA + patients. Surgical outcomes were compared between groups. Of the 33,854 patients evaluated, 711 were included in final matched analysis (237 per group).
The MRSA + TJA patients had longer hospital lengths of stay (P = .008), were less likely to discharge home (P = .003), and had higher 30-day (P = .030) and 90-day (P = .033) readmission rates compared to MSSA+ and MSSA/MRSA-patients, though 90-day major and minor complications were comparable across groups. MRSA + patients had higher rates of all-cause (P = .020), aseptic (P = .025) and septic revisions (P = .049) compared to the other cohorts. These findings held true for both total knee and total hip arthroplasty patients when analyzed separately.
Despite targeted perioperative decolonization, MRSA + patients undergoing TJA have longer lengths of stay, higher readmission rates, and higher septic and aseptic revision rates. Surgeons should consider patients' preoperative MRSA colonization status when counseling on the risks of TJA.
耐甲氧西林金黄色葡萄球菌（MRSA）术前鼻腔定植对全关节置换术（TJA）结局的影响尚不清楚。本研究旨在根据患者术前葡萄球菌定植状态评估 TJA 后的并发症。
我们回顾性分析了 2011 年至 2022 年间所有接受初次 TJA 且完成术前鼻腔拭子葡萄球菌定植培养的患者。根据基线特征，采用 1:1:1 倾向评分匹配患者，并根据定植状态将患者分为 3 组：MRSA 阳性（MRSA+）、甲氧西林敏感金黄色葡萄球菌阳性（MSSA+）和 MSSA/MRSA 阴性（MSSA/MRSA-）。所有 MRSA+和 MSSA+患者均采用 5%聚维酮碘进行去定植治疗，MRSA+患者加用静脉万古霉素。比较各组之间的手术结果。在评估的 33854 例患者中，最终匹配分析纳入 711 例（每组 237 例）。
MRSA+TJA 患者的住院时间更长（P=0.008），更不可能出院回家（P=0.003），30 天（P=0.030）和 90 天（P=0.033）的再入院率更高，尽管各组 90 天主要和次要并发症相当。与 MSSA+和 MSSA/MRSA-患者相比，MRSA+患者的全因（P=0.020）、无菌性（P=0.025）和感染性翻修（P=0.049）率更高。当分别分析全膝关节和全髋关节置换术患者时，也发现了同样的结果。
尽管进行了有针对性的围手术期去定植治疗，但接受 TJA 的 MRSA+患者的住院时间更长、再入院率更高、感染性和无菌性翻修率更高。外科医生在对 TJA 风险进行咨询时应考虑患者术前 MRSA 定植状态。
